Healthcare Provider Details

I. General information

NPI: 1306053673
Provider Name (Legal Business Name): MOUNDS VIEW CHIROPRACTIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5372 EDGEWOOD DR
SAINT PAUL MN
55112-1402
US

IV. Provider business mailing address

5372 EDGEWOOD DR
SAINT PAUL MN
55112-1402
US

V. Phone/Fax

Practice location:
  • Phone: 763-398-7770
  • Fax: 763-398-7771
Mailing address:
  • Phone: 763-398-7770
  • Fax: 763-398-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4950
License Number StateMN

VIII. Authorized Official

Name: DR. JOSHUA RYAN HUFFMAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 763-398-7770